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Exercise training does not alter left ventricular strain in top-level athletes: a prospective, longitudinal speckle-tracking study

Session Moderated Poster Session V - Sports Cardiology

Speaker Assistant Professor Flavio D'Ascenzi

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2015

  • Topic : preventive cardiology
  • Sub-topic : Sports Cardiology
  • Session type : Moderated Posters

Authors : F D'ascenzi (Siena,IT), A Pelliccia (Rome,IT), M Focardi (Siena,IT), F Alvino (Siena,IT), M Cameli (Siena,IT), V Andrei (Siena,IT), A Loffreno (Siena,IT), M Solari (Siena,IT), M Bonifazi (Siena,IT), S Mondillo (Siena,IT)

F D'ascenzi1 , A Pelliccia2 , M Focardi1 , F Alvino1 , M Cameli1 , V Andrei1 , A Loffreno1 , M Solari1 , M Bonifazi3 , S Mondillo1 , 1University of Siena, Department of Cardiovascular Diseases - Siena - Italy , 2Institute of Sport Medicine and Science, CONI - Rome - Italy , 3University of Siena, Department of Medicine, Surgery, and NeuroScience - Siena - Italy ,


Background.  Left ventricular (LV) longitudinal strain, a recognized marker of LV function, has been recently applied to the evaluation of the athlete’s heart. At present, little is known about the influence of potential changes in LV global longitudinal strain (GLS) in athletes after training. Aim of this study was to prospectively investigate the impact of training on LV longitudinal strain in a cohort of top-level athletes.

Methods and Results.  91 athletes, practicing team sports and competing at national or international level, were analysed. Echocardiographic evaluation was performed at the beginning of the season (low-training) and after 18±2 weeks of a supervised, intensive training program (peak-training). A significant increase in LV mass (p<.0001), LV end-diastolic and end-systolic volume (p=.001 and p<.0001, respectively) was found at peak-training. LV basal and apical torsion (p=.59 and p=.43, respectively) and LV twisting (p=.78) did not change, and only a mild increase in LV GLS was evident after training (p<.05). Conversely, neither global circumferential strain nor global radial strain did significantly change. Resting heart rate was the only independent predictor of LV strain after training (ß=0.30, p=.005).

Conclusions. A mid-term (18-week) intensive training program induces only a slight increase in LV GLS and neither global circumferential strain nor global radial strain did change in top-level athletes practicing team sports, despite a marked increase in LV size. Thus, markedly altered strain indexes are uncommon features in athlete’s heart and cannot be considered as a physiological adaptation to exercise training.

Top-level athletes (n=91)




P value


119.3 ± 30.1

127.8 ± 33.9


LVM index, g/m2

82.6 ± 19.8

93.1 ± 22.6


e’/a’ ratio

2.3 ± 0.5

2.7 ± 1.1


Global longitudinal strain, %

-20.2 ± 2.1

-20.8 ± 2.4


Global basal radial, %

31.1 ± 14.8

33.4 ± 15.6


Global apical radial, %

26.3 ± 16.0

26.8 ± 16.1


Global basal circumferential strain, %

-17.4 ± 3.7

-17.2 ± 4.4


Global apical circumferential strain, %

-25.0 ± 8.8

-25.2 ± 7.5


LVEDV, left ventricular end-diastolic volume; LVM, left ventricular mass.

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